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The Annals of Thoracic Surgery, Vol 49, 195-201, Copyright © 1990 by The Society of Thoracic Surgeons
DL Galbut, EA Traad, MJ Dorman, PL DeWitt, PB Larsen, PA Kurlansky, JH Button, JM Ally and TO Gentsch
The internal mammary artery (IMA) is being recognized as the conduit of
choice for myocardial revascularization. From January 1972 through June
1988, 1,087 patients received bilateral IMA and supplemental vein grafts.
There were 917 men (84.4%) and 170 women (15.6%) with a mean age of 62.4
years (range, 29 to 84 years). Three hundred ninety-four patients (36.2%)
had unstable angina, and 194 (17.8%) had left main coronary artery stenosis
greater than 50%. In all, 3,741 coronary grafts were performed, with a mean
of 3.4 per patient. Hospital mortality was 2.7% (29 patients). Hospital
complications included reoperation for bleeding, 19 patients (1.7%);
sternal infection, 16 patients (1.5%); respiratory failure, 35 patients
(3.2%); perioperative myocardial infarction, 22 patients (2.0%); and
stroke, 20 patients (1.8%). Post-operative arteriography in 53 patients
(mean postoperative time, 53.0 months) showed that 92.1% (58/63) of the
left IMA and 84.9% (45/53) of the right IMA grafts were patent. Follow-up
was completed on 1,058 hospital survivors. There were 82 late deaths
(7.8%). The actuarial survival for patients discharged from the hospital
was 80.0 +/- 3.2% (plus or minus standard error of the mean) at 10 years
and 60.0% +/- 5.0% at 15 years. At follow-up, 866 patients (90.3%) were
asymptomatic and in New York Heart Association class I and 68 (7.1%) were
in class II. This longitudinal analysis demonstrates that bilateral IMA
grafting has a low operative risk and provides excellent long-term
functional improvement and survival.
ARTICLES
Seventeen-year experience with bilateral internal mammary artery grafts
Miami Heart Institute, Florida.
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E. Dregelid, K. Heldal, F. Resch, L. Stange |
